Chinese Journal Review: COVID-19 Complicates Malaria Eradication Efforts

China typically sees spikes of imported malaria during Chinese New Year when many migrant workers return home from malaria-endemic countries. This year, that coincided with the COVID-19 outbreak.

Two medical journals recently published pieces regarding COVID-19 and associated difficulties of combatting malaria. I’ve summarized one of those articles below and included a link to the second. 

In the first, published in the Chinese Journal of Schistosomiasis Control, the authors write that COVID-19 has complicated China’s malaria elimination activities. While China has reported zero new indigenous cases of malaria since 2017, it sees nearly 3,000 imported cases each year. A large proportion of these cases happen during the Chinese New Year, when many migrant workers return home to China, including from malaria-endemic countries. This year, Chinese New Year coincided with the outbreak of COVID-19. Failure to treat malaria promptly increases the risk to patients and of secondary malaria transmission. Given COVID-19’s presently high incidence, health professionals are prone to misdiagnose malaria patients who have similar symptoms as COVID-19, such as high fever. (Longer summary below)

In the second, published in the Chinese Journal of Parasitology and Parasitic Diseases, the authors provide guidance for health professionals regarding the diagnosis and treatment of suspected malaria patients in light of the COVID-19 outbreak. Among their recommendations, the authors suggest that health professionals use the Internet for remote consultations. They also provide guidelines regarding when and how to hospitalize (non-severe malaria patients should be sent home with oral medication; patients with severe malaria should be hospitalized and isolated and kept away from COVID-19 patients), as well as which tests to perform.

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Title: Challenges and countermeasures on Chinese malaria elimination programme during the coronavirus disease (COVID-19) outbreak (新型冠状病毒肺炎疫情对我国消除疟疾工作的挑战及应对策略)
Journal: Chinese Journal of Schistosomiasis Control (中国血吸虫病防治杂志)
Author: Zhu Guoding (朱国鼎) and Cao Jun (曹俊) from the Jiangsu Institute of Parasitic Disease Control, a WHO Collaborating Centre for Research and Training on Malaria Elimination
Link: https://bit.ly/334fVUf
Publication Date: February 2020

• While China has reported zero new cases of malaria for three consecutive years since 2017, it sees approximately 3,000 imported cases each year. If health professionals do not identify and treat these cases promptly, this brings risks to the patient and to the community through secondary malaria transmission.

• The COVID-19 outbreak coincided with the Chinese New Year, which is when many migrant workers return home from working overseas. China generally experiences a high incidence of imported malaria cases during this time.

• The most common form of imported malaria in China is falciparum malaria, which is also the most dangerous. It progresses rapidly and can be fatal if not treated promptly. As a result of the government’s quarantine strategy and patients’ fear that going to the hospital may lead to COVID-19 infection, patients with imported malaria and other diseases have likely opted to stay home and self-treat. In February, a malaria patient in Jiangsu province chose to take cold medicine at home instead of going to a local hospital. Within three days, he developed severe symptoms, lost consciousness, and was sent to the ICU for emergency treatment.

• For those malaria patients who do seek medical assistance, COVID-19 is complicating their quality of care. Malaria and COVID-19 share many of the same symptoms, such as high fever, so it is easy for medical professionals to misdiagnose malaria patients. Authorities have also converted facilities previously designated as special malaria treatment centers into COVID-19 treatment centers, which reduces the services available to malaria patients. Malaria patients who seek services at these centers are also at increased risk of nosocomial COVID-19 infection. Many of the country’s malaria treatment experts have been dispatched to Wuhan. 

• Epidemiologists, health care professionals, and lab personnel should be aware that malaria patients may also be co-infected with COVID-19. Health care professionals who collect blood samples or who are in direct contact with malaria patients and their family members should use proper protection.

• Health institutions and disease prevention and control agencies should make full use of platforms such as Weibo and WeChat to increase public awareness about malaria. Migrant workers who have travel history to malaria-endemic regions and experience symptoms such as a high fever should seek medical treatment. They should avoid staying at home and should make their travel history known to medical personnel. 

• To minimize the risk of potential exposure for patients and health professionals to COVID-19, health facilities can also make better use of technology to diagnose, treat, and investigate malaria transmission. For example, health professionals can use the Internet for medical consultations with malaria patients, remote visualization equipment to perform epidemiological investigations, and microscope imaging systems to review blood samples. 

Note: Cao Jun, one of this paper’s co-authors, is the Executive Director of the WHO Collaborating Centre for Research and Training on Malaria Elimination